Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: a systematic review and meta-analysis

Jones, L, Bates, G, McCoy, E and Bellis, MA
(2015)
Relationship between alcohol-attributable disease and socioeconomic status, and the role of alcohol consumption in this relationship: a systematic review and meta-analysis.
BMC PUBLIC HEALTH, 15 (400).
ISSN 1471-2458

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Abstract

Background: Studies show that alcohol consumption appears to have a disproportionate impact on people of low socioeconomic status. Further exploration of the relationship between alcohol consumption, socioeconomic status and the development of chronic alcohol-attributable diseases is therefore important to inform the development ofeffective public health programmes.Methods: We used systematic review methodology to identify published studies of the association betweensocioeconomic factors and mortality and morbidity for alcohol-attributable conditions. To attempt to quantifydifferences in the impact of alcohol consumption for each condition, stratified by SES, we (i) investigated the relationship between SES and risk of mortality or morbidity for each alcohol-attributable condition, and (ii) where, feasible explored alcohol consumption as a mediating or interacting variable in this relationship.Results: We identified differing relationships between a range of alcohol-attributable conditions and socioeconomicindicators. Pooled analyses showed that low, relative to high socioeconomic status, was associated with an increasedrisk of head and neck cancer and stroke, and in individual studies, with hypertension and liver disease. Conversely, risk of female breast cancer tended to be associated with higher socioeconomic status. These findings were attenuatedbut held when adjusted for a number of known risk factors and other potential confounding factors. A key finding wasthe lack of studies that have explored the interaction between alcohol-attributable disease, socioeconomic status and alcohol use.Conclusions: Despite some limitations to our review, we have described relationships between socioeconomicstatus and a range of alcohol-attributable conditions, and explored the mediating and interacting effects of alcoholconsumption where feasible. However, further research is needed to better characterise the relationship betweensocioeconomic status alcohol consumption and alcohol-attributable disease risk so as to gain a greater understanding of the mechanisms and pathways that influence the differential risk in harm between people of low and highsocioeconomic status.